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PROPERTY & CASUALTY INSURERSCOMPANY NAME:NAIC Company Code:Contact:Telephone:REQUIRED FILINGS IN THE STATE OF:Filings Made During the Year 2022Maryland*DOMICILED COMPANIES – DUE TO THE COVID-19 PANDEMIC, ALL 2021 ANNUAL STATEMENTAND 2022 QUARTERLY FILINGS ARE PERMITTED TO BE SUBMITTED ELECTRONICALLY.COMPANIES SHOULD RETAIN ONE HARD COPY TO BE FILED WITH THE MARYLAND INSURANCEADMINISTRATION UPON REQUEST AT A LATER DATE. ELECTRONIC SIGNATURES WILL BEACCEPTED. PLEASE SEE FILING INSTRUCTIONS BELOW(1)(2)(3)ChecklistLine #REQUIRED FILINGS FOR THE ABOVE STATE11.1I. NAIC FINANCIAL STATEMENTSAnnual Statement (8 ½” x 14”)Printed Investment Schedule detail (Pages E01-E29)2341112131415161718192021222324(4)NUMBER OF arterly Financial Statement (8 ½” x 14”)1EOxxxProtected Cell Annual StatementCombined Annual Statement (8 ½” x OxxxII. NAIC SUPPLEMENTSAccident & Health Policy Experience ExhibitActuarial OpinionActuarial Opinion SummaryBail Bond SupplementCombined Insurance Expense ExhibitCredit Insurance Experience ExhibitCybersecurity and Identity Theft InsuranceCoverage SupplementDirector and Officer Insurance CoverageSupplementFinancial Guaranty Insurance ExhibitInsurance Expense ExhibitLife, Health & Annuity Guaranty AssociationAssessable Premium Exhibit, Parts 1 and 2Long-Term Care Experience Reporting FormsManagement Discussion & AnalysisMedicare Part D Coverage Supplementxxx(5)DUE DATE3/13/15/15, 4/1NAIC1EOxxx11EOEOxxxxxx3/1, 5/15,8/15, /14/13/1, 5/15,8/15, NAICNAICNAIC252627282930313233Medicare Supplement Insurance Experience ExhibitMortgage Guaranty Insurance ExhibitPremiums Attributed to Protected Cells ExhibitPrivate Flood Insurance SupplementReinsurance Attestation SupplementExceptions to Reinsurance Attestation SupplementReinsurance Summary SupplementalRisk-Based Capital ReportSchedule N/A34Supplement A to Schedule T1EOxxx3536Supplemental Compensation ExhibitSupplemental Health Care Exhibit (Parts 1, 2 and 3)Supplemental Health Care Exhibit’s AllocationReport SupplementSupplemental Investment Risk InterrogatoriesSupplemental Schedule for ReinsuranceCounterparty Reporting Exception – Asbestos andPollution Contractsxxx1N/AEON/Axxx3/14/13/13/13/13/13/13/1, 5/15,8/15, 1EOxxx3/1, 5/15,8/15, steed Surplus Statement6162III. ELECTRONIC FILING REQUIREMENTSAnnual Statement Electronic FilingMarch .PDF Filing 2020 National Association of Insurance operty/Casualty
(1)(2)(3)ChecklistLine #REQUIRED FILINGS FOR THE ABOVE STATE636465666768Risk-Based Capital Electronic FilingRisk-Based Capital .PDF FilingCombined Annual Statement Electronic FilingCombined Annual Statement .PDF FilingSupplemental Electronic FilingSupplemental .PDF Filing69Quarterly Statement Electronic Filing(4)NUMBER OF xxxxEOEOEOEOEOEON/AN/AxxxxxxxxxxxxxxxEOxxx(5)DUE DATE3/13/15/15/14/14/15/15, 8/15,11/155/15, 8/15,11/156/170Quarterly .PDF FilingxxxEOxxx71June .PDF 8586878889909192IV. AUDIT/INTERNAL CONTROLRELATED REPORTSAccountants Letter of QualificationsAudited Financial ReportsAudited Financial Reports Exemption AffidavitCommunication of Internal Control Related MattersNoted in AuditIndependent CPA (change)Management’s Report of Internal Control OverFinancial ReportingNotification of Adverse Financial ConditionRelief from the five-year rotation requirement forlead audit partnerRelief from the one-year cooling off period forindependent CPARelief from the Requirements for Audit CommitteesRequest to File Consolidated Audited AnnualStatementsRequest for Exemption to File Management’sReport of Internal Control Over Financial pany8/1CompanyCompanyV. STATE REQUIRED FILINGS***101Corporate Governance Annual Disclosure***(see NOTES and INSTRUCTIONS below)10xxx6/1Company102Holding Company registration Statement (formsB&C)(see NOTES and INSTRUCTIONS below)10xxx5/1State103Insurance Holding Company System ModelRegulations, form F, Enterprise Risk Report (Model450-27)(see NOTES and INSTRUCTIONS below)10xxx7/1State104ORSA10xxx 2020 National Association of Insurance Commissioners2(7)APPLICABLENOTESCompanyRefer to Title4, Subtitle %of theInsuranceArticleRefer toSection 7-601of InsuranceArticleRefer tosection 7-603(h) of theInsuranceArticleRefer to Title32 ofInsuranceArticleProperty/Casualty
(1)(2)(3)ChecklistLine #REQUIRED FILINGS FOR THE ABOVE STATE105(4)NUMBER OF COPIES*DomesticForeignStateNAICStatePremium Tax Statement101(5)DUE DATE(6)FORMSOURCE**(7)APPLICABLENOTES6-102 of ENTFILINGS: DUETO THECOVID -19PANDEMIC ITISRECOMMENDED THATCOMPANIESFILE VIAEMAIL ORTHROUGHOPTINS.PLEASE SEEMIA @maryland.gov106Maryland Retaliatory Deposit Schedule(see NOTES and INSTRUCTIONS below)10xxx4/1For Arizona,California ionin Maryland109110111*If XXX appears in this column, this state does not require this filing, if hard copy is filed with the state of domicile and if the data is filed electronicallywith the NAIC. If N/A appears in this column, the filing is required with the domiciliary state. EO (electronic only filing).**If Form Source is NAIC, the form should be obtained from the appropriate vendor.***For those states that have adopted the NAIC Corporate Governance Annual Disclosure Model Act, an annual disclosure is required of all insurersor insurance groups by June 1. The Corporate Governance Annual Disclosure is a state filing only and should not be submitted by the company tothe NAIC. Note however that this filing is intended to be submitted to the lead state if filed at the insurance group level. For more information onlead states, see the following NAIC URL: http://www.naic.org/public lead state report.htm.****For those states that have adopted the NAIC updated Holding Company Model Act, a Form F filing is required annually by holding companygroups. Consistent with the Form B filing requirements, the Form F is a state filing only and should not be submitted by the company to the NAIC.Note however that this filing is intended to be submitted to the lead state. For more information on lead states, see the following NAIC URL:http://www.naic.org/public lead state report.htm*****For those states that have adopted the NAIC Risk Management and Own Risk and Solvency Assessment Model Act, a summary report isrequired annually by insurers and insurance groups above a specified premium threshold. The ORSA Summary Report is a state filing only andshould not be submitted by the company to the NAIC. Note however that this filing is intended to be submitted to the lead state if filed at the insurancegroup level. For more information on lead states, see the following NAIC URL: http://www.naic.org/public lead state report.htm 2020 National Association of Insurance Commissioners3Property/Casualty
ABNOTES AND INSTRUCTIONSRequired Filings Contact Person:Attn: Lynn IC COMPANIES - COVID-19 EMERGENCYINSTRUCTIONSElectronic Filing Instructions:Completed Annual Statement, Quarterly Statement and relatedsupplemental filings should be submitted to the Maryland InsuranceAdministration via email at:eafilings.mia@maryland.govHolding company filings (Forms A, B, C, D, E, F, and CorporateGovernance Annual Disclosure) should be submitted to the MarylandInsurance Administration via emailat: holdingcompanyfiling.mia@maryland.govDOMESTIC COMPANIES - COVID-19 EMERGENCYINSTRUCTIONSElectronic Signatures:Electronic filings should contain electronic signaturesCDEFGHIThe MIA generally instructs companies to file certain documents in hardcopy form with original (wet) signature, and in some cases sent viacertified mail or first-class and with notary requirements. The hard copy,original (wet) signature, and related filing requirements are currentlywaived, however, companies are expected to file the documentselectronically.The electronic filing should contain electronicsignatures. The companies should retain a hard copy so that they canfile the hard copy, at a later date if requested by the Maryland InsuranceAdministration. With respect to the hard copies to be filed, therequirement for wet signatures is waived.Mailing Address:Examination and Auditing UnitMaryland Insurance Administration200 St. Paul Place, Suite 2700Baltimore, MD 21202Mailing Address for Filing Fees:Maryland Insurance AdministrationAttn: Shanell Hurt Franklin or Spencer HarrisFiscal Unit200 St. Paul Place, Suite 2700Baltimore, MD 21202Mailing Address for Premium Tax Payments:Maryland Insurance AdministrationAttn: Shanell Hurt Franklin or Spencer HarrisFiscal Unit200 St. Paul Place, Suite 2700Baltimore, MD 21202Delivery Instructions:Electronic postmark on or before due dateLate Filings:Subject to penalty and interestOriginal Signatures:Yes 2020 National Association of Insurance Commissioners4Domestic insurers – Due to theCOVID-19 pandemic, electronicsignatures will be accepted forall filings.Property/Casualty
mestic insurers –Notarization/Certification shouldbe electronic, if possible.Amended Filings:YesExceptions from normal filings:Approval must be in writingBar Codes (State or NAIC):NAICSigned Jurat:NONE Filings:YesFilings new, discontinued or modified materially since last year:YesLine 103, Insurance Holding Company System Model Regulation,Form F, Enterprise Risk Report (Model 450-27)RRetaliatory Deposit ScheduleSAdditional Questions: 2020 National Association of Insurance Commissioners5Signed Jurat page is no longerrequired for foreign insurers.Domestic insurers – Jurat pageshould contain electronicsignatures.Refer to Section 7-603(h) of theInsurance Article.Email toMatt.Kozak@maryland.govRefer to “Reports due fromRegulated entities to theMaryland InsuranceAdministration” found on theMia website anyfilingRequirements.aspx, under Summary ofMaryland Required FilingsProperty/Casualty
General InstructionsFor Companies to Use ChecklistPlease Note:This state’s instructions for companies to file with the NAIC are included in this Checklist. The NAICwill not be sending their own checklist this year.Electronic filing is intended to be filing(s) submitted to the NAIC via the NAIC Internet Filing Sitewhich eliminates the need for a company to submit diskettes or CD-ROM to the NAIC. Companies arenot required to file hard copy filings with the NAIC.Column (1)ChecklistCompanies may use the checklist to submit to a state, if the state requests it. Companies should copy the checklist and placean “x” in this column when submitting information to the state.Column (2)Line #Line # refers to a standard filing number used for easy reference. This line number may change from year to year.Column (3)Required FilingsName of item or form to be filed.The Annual Statement Electronic Filing includes the annual statement data and all supplements due March 1, per the AnnualStatement Instructions. This includes all detail investment schedules and other supplements for which the Annual StatementInstructions exempt printed detail.The March .PDF Filing is the .pdf file for annual statement data, detail for investment schedules and supplements due March1.The Risk-Based Capital Electronic Filing includes all risk-based capital data.The Risk-Based Capital.PDF Filing is the .pdf file for risk-based capital data.The Supplemental Electronic Filing includes all supplements due April 1, per the Annual Statement Instructions.The Supplemental.PDF Filing is the .pdf file for all supplemental schedules and exhibits due April 1.The Quarterly Statement Electronic Filing includes the complete quarterly statement data.The Quarterly Statement.PDF Filing is the .pdf file for quarterly statement data.The Combined Annual Statement Electronic Filing includes the required pages of the combined annual statement and thecombined Insurance Expense Exhibit.The Combined Annual Statement.PDF Filing is the .pdf file for the Combined annual statement data and the combinedInsurance Expense Exhibit.The June .PDF Filing is the .pdf file for the Audited Financial Statements and Accountants Letter of Qualifications.Column (4)Number of CopiesIndicates the number of copies that each foreign or domestic company is required to file for each type of form. The Blanks(EX) Task Force modified the 1999 Annual Statement Instructions to waive paper filings of certain NAIC supplements andcertain investment schedule detail if such investment schedule data is available to the states via the NAIC database. Thechecklists reflect this action taken by the Blanks (EX) Task Force. XXX appears in the “Number of Copies” “Foreign” columnfor the appropriate schedules and exhibits. Some states have chosen to waive printed quarterly and annual statements fromtheir foreign insurers and to rely upon the NAIC database for these filings. This waiver could include supplemental annualstatement filings. The XXX in this column might signify that the state has waived the paper filing of the annual statementand all supplements. 2020 National Association of Insurance Commissioners6Property/Casualty
Column (5)Due DateIndicates the date on which the company must file the form.Column (6)Form SourceThis column contains one of three words: “NAIC,” “State,” or “Company,” If this column contains “NAIC,” the company mustobtain the forms from the appropriate vendor. If this column contains “State,” the state will provide the forms with the filinginstructions. If this column contains “Company,” the company, or its representative (e.g., its CPA firm), is expected to providethe form based upon the appropriate state instructions or the NAIC Annual Statement Instructions.Column (7)Applicable NotesThis column contains references to the Notes to the Instructions that apply to each item listed on the checklist. The companyshould carefully read these notes before submitting a filing. 2020 National Association of Insurance Commissioners7Property/Casualty
COMPANY NAME: NAIC Company Code: Contact: Telephone: REQUIRED FILINGS IN THE STATE OF: . Line 103, Insurance Holding Company System Model Regulation, Form F, Enterprise Risk Report (Model 450-27) Refer to Section 7-603(h) of the Insurance Article. R . Retaliatory Deposit Schedule .
